Thursday, June 6, 2013

Recovery from Climbing Finger Pulley Tendon Injuries



I have spent most of the last 8 weeks training in preparation for a trip to the Tetons.  There has been a  lot of cardio-paced hour-long bouldering circuits, sport-specific exercises, endurance runs up and over mountains and rock faces here in North Carolina, and interval weight lifting cross training.

Unfortunately, my training plans were significantly derailed on May 7 when I injured my left middle finger during one of the aforementioned bouldering circuits.  After an initial evening of forlorn spectatorship as I spotted my friends while they bouldered, I realized that I had two very positive things going for me.  The first was the timing.  May 7 was almost exactly 4 weeks before we were scheduled to leave.  Had the injury happened any later, I might not have been in the best climbing shape.  Second, as this was my third finger injury, I had a pretty good idea of how best to help it heal quickly.  I thought others might also benefit from this knowledge.

A Quick Anatomy Lesson

By far the most common finger injury in rock climbing is a hyper-flexion of the distal inter-phalangeal (DIP) joint or the proximal inter-phalangeal (PIP) joint resulting in the partial or complete tear of the A2 and/or A4 pulley tendon(s), commonly in the ring or middle fingers, but also possible in the index finger and little finger.  This injury is usually caused by the climber adopting a “full crimp” grip or a one- or two-finger “pocket” grip.

In less technical terms, the PIP and the DIP are the finger joints closest and furthest from the hand, respectively.  On the palm-side of each finger is a tendon that basically runs from the end of the finger, along the finger, through the hand, and into the muscles of the forearms.  When the muscle flexes, it pulls on this tendon, which allows the hand to close.  Since the tendon attaches to the end of the finger, other assistive tendons called “pulleys” wrap around the individual finger bones to help hold the tendon in place.  When a climber crimps on a tiny hold, it is possible for these assistive pulleys to tear.

A tendon tear is more commonly referred to as a “sprain” or “strain,” but a tendon tear may be more thoroughly described as either a partial or full tear.  In general, climbing pulley injuries are partial tears.  The injury is frequently associated with a “popping” sound while pulling on a crimper or pocket, painful touch sensitivity to the affected area, pain when moving through the affected range of motion, and possibly swelling.


Disclaimer

I am not a doctor, physical therapist, or anything else that might come with a degree, certificate, or license to be dispensing medical advice.  However, I have injured 5 pulleys now and have researched the matter pretty thoroughly.  Use this information at your own risk.

How to heal as quickly as possible

The good news is that most partial pulley tears will heal on their own if given enough time.  (Full tears may require surgery - see a doctor).  The bad news is that since the fingers don’t receive much circulation, they tend to heal relatively slowly.  For minor injuries, 2 - 3 weeks might be sufficient, but serious or multiple tears may not fully heal for months.  That being said, here is what I have had success with:

1.  STOP CLIMBING.  This will likely be easily initially due to the pain, but may take greater resolve as time advances.  I usually try to take 2 whole weeks off from any climbing if possible (though my line of work does not always allow this).  This should give time for the swelling to reduce and healing to take place enough that other therapy is effective.

2.  Start cryotherpay.  This is a fancy way of saying put ice on it.  Apply ice to the affected finger for 20 - 30 minutes 4 or 5 times a day.  This will help reduce swelling, alleviate pain, and encourage circulation as the finger re-warms.  Icing can be started the day of the injury and continued for a few weeks as long as it is effective.

3.  Deep friction massage can be effective after the injury has had 1 to 2 weeks to heal on its own. Apply heavy pressure and massage the finger down its length in the affected area.  A few minutes 3 or 4 times a day may be helpful in increasing circulation.

4.  Stretching and range of motion exercises are helpful once the injury has had a few weeks to heal.  These activities may cause some pain, but there should be no sharp or acute pain associated with them.  If there is, wait a few more days so the finger has more time to heal before starting.  A few times a day, work the finger through its full range of motion, bending and straightening it and doing a few circles.  Finish with hyperextension stretching, straightening the finger and pulling it back with the opposite hand.  I typically combine all three of these into one “therapy session,” starting with icing, than massaging, then stretching.

5.  For those who truly need to climb as soon as possible, some evidence suggests that a moderate open-hand grip hangboard session a few times a week can speed healing by increasing circulation and serving a similar function as range of motion exercise.  However, this comes with the risk of causing further injury to the finger and also demands great discipline to not accidentally aggravate the injury.  I would not recommend this unless you’re competing in the world cup or it’s imperative that you send your next V12 project tomorrow.  Of course, if that’s the case, you probably already know how to treat pulley injuries.

6.  Taping can have some beneficial effect in preventing re-injury when you finally resume climbing.  I usually give it about 4 weeks post-injury before any serious attempts to climb again.  Tape needs to be applied quite tightly to be effective and should be applied just behind both finger joints.  If the tape is too tight it will restrict circulation to the finger tip, so I usually wrap the tape quite snugly on the underside of the finger and more loosely on top.  This seems to work well.  After about 2 weeks of climbing with tape, you can begin tentative forays into tape-free climbing until you feel 100% recovered.

A few other notes:  I personally avoid taking NSAIDs therapeutically unless they are needed for pain maintenance.  There is some evidence to suggest that long-term use of NSAIDs may have detrimental effects on joints and may actually slow the healing process.  Also, while taping can be useful for rehabilitation post-injury, the evidence does not seem to support the notion that taping has any injury preventing effects.

Further Reading


15 comments:

  1. Tip # 1 is definitely the most important one to follow. Some climbers tend to just power over the pain and continue to train despite injured fingers. Some stop but start climbing again after a few days to “test if it’s still injured”, more often than not re-injuring themselves. The best thing to do is to do training and stretching that doesn’t focus much on your hands to give them time to heal. The massage and ice definitely help alleviate the pain that spikes up from time to time.

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    Replies
    1. I did this and injured it worse. I'm out of climbing for 3 months and have to wear an A2 Pulley Ring Splint. There is also a possibility to rupture the A2 pulley if you keep climbing on the injury. A ruptured A2 pulley means no more climbing again and surgery to regain the use of the hand.

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